Subdural Empyema
Subdural Empyema
Subdural Empyema (SDE) is a severe, rapidly progressive, and life-threatening brain infection in which pus accumulates between the dura mater and arachnoid mater—two protective layers surrounding the brain. In children, especially infants and young adolescents, SDE often occurs as a complication of untreated sinus infections, ear infections, or meningitis, and it can lead to seizures, coma, or death if not promptly managed. Pediatric Subdural Empyema demands emergency neurosurgical drainage, appropriate intravenous antibiotics, and intensive monitoring, especially in resource-constrained settings like Bangladesh, where delays in diagnosis are still common. Dr. Md. Nafaur Rahman, a leading pediatric neurosurgeon in Bangladesh, has successfully managed numerous complex SDE cases, offering life-saving interventions and long-term neurological care at both NINS and Bangladesh Paediatric Neurocare Centre. 🌍 Pediatric SDE in Bangladesh: A Critical Yet Underdiagnosed Condition In Bangladesh, Subdural Empyema in children is often misdiagnosed as meningitis or encephalitis due to overlapping symptoms. Contributing local factors include: 👂 Untreated ear infections (chronic otitis media) 👃 Neglected sinusitis or upper respiratory infections 🦠 Poor infection control in rural healthcare setups ⏰ Delay in neuroimaging due to lack of access ❌ Inadequate antibiotic treatment in early stages 🧬 Congenital immune deficiencies or malnutrition By raising awareness and offering prompt neurosurgical services, Dr. Nafaur Rahman aims to reduce preventable mortality and disability caused by subdural empyema in Bangladeshi children. ⚠️ Common Symptoms of Pediatric Subdural Empyema SDE typically develops after a prior infection and symptoms escalate rapidly. Parents and physicians should look for: 🌡️ High, persistent fever 😵💫 Severe headache and irritability ⚡ Seizures (especially new-onset in febrile children) 🧍 Limb weakness or one-sided paralysis 😴 Altered consciousness or lethargy 👁️ Visual changes, squint, or cranial nerve palsy 🔁 Worsening symptoms after apparent recovery from sinusitis or meningitis “When a child has persistent fever, seizure, and progressive drowsiness after an ear or sinus infection—subdural empyema must be suspected urgently.” — Dr. Md. Nafaur Rahman 🧬 Causes and Risk Factors of SDE in Children Major Causes in the Bangladeshi Pediatric Population: 🧠 Spread from bacterial meningitis 👃 Extension of frontal or ethmoid sinusitis 👂 Complication of chronic ear infections or mastoiditis 💥 Post-traumatic or post-surgical infection 🧬 Immunocompromised states such as leukemia, malnutrition, or HIV Common pathogens include Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and anaerobic bacteria. 🧪 Diagnostic Approach at NINS & Bangladesh Paediatric Neurocare Centre Accurate and rapid diagnosis is vital. Dr. Nafaur Rahman utilizes state-of-the-art diagnostic tools available at both public and private facilities. Key Diagnostic Tools: 🧠 MRI Brain with contrast – Best for detecting empyema, midline shift, and edema 📸 CT Scan of the brain – Useful for emergency assessment 💉 CBC, ESR, CRP, Blood cultures – To track systemic infection 🧫 CSF analysis – Usually avoided in high-pressure cases 👂 ENT imaging – To assess the origin of the infection (ear/sinus) 🛠️ Treatment Options: Emergency Surgical Drainage + Antibiotics Pediatric SDE must be treated aggressively and urgently, combining neurosurgical evacuation with targeted antibiotics. 🔧 Neurosurgical Procedures: Burr Hole Evacuation Quick and effective for thin-layered or uniloculated empyema Minimally invasive and often performed under local or general anesthesia Craniotomy Required for thick, multiloculated, or recurrent empyema Allows thorough evacuation and brain decompression Often guided by neuronavigation in complex cases CSF Diversion (VP Shunt) For cases complicated by hydrocephalus Helps relieve pressure and prevent herniation 💊 Antibiotic Management: High-dose IV antibiotics for 4–6 weeks Regimen tailored based on culture sensitivity May include antitubercular therapy in endemic areas like Bangladesh “In subdural empyema, every hour counts. The faster we operate, the higher the chance of saving the child’s life and brain.” — Dr. Md. Nafaur Rahman 🔁 Long-Term Recovery and Follow-Up Post-operative care and rehabilitation are vital for full neurological recovery. At Bangladesh Paediatric Neurocare Centre, follow-up care includes: 🧠 Repeat imaging (MRI or CT) to confirm resolution ⚕️ Neurological assessments and seizure management 🗣️ Speech and cognitive therapy for developmental delays 🧑🏫 School reintegration and behavioral counseling 💡 Parental guidance to prevent reinfection and monitor red-flag symptoms 🚨 What Happens If SDE Is Left Untreated? Untreated or late-diagnosed subdural empyema can lead to: ⚰️ Brain herniation and death 🧑🦽 Permanent paralysis or loss of vision ⚡ Chronic epilepsy or intellectual disability 🧠 Recurrent infections and hydrocephalus 🛌 Developmental regression and learning disability 👨⚕️ Why Trust Dr. Md. Nafaur Rahman for Pediatric Brain Infections? 🧠 Highly skilled in minimally invasive and open neurosurgery for pediatric infections 🏥 Operates at National Institute of Neurosciences & Hospital (NINS) 👨👩👧 Offers family-centered pediatric care and infection control 📈 High success rates with early referral and tailored post-op follow-up 🩺 Coordinates multidisciplinary care with pediatricians, neurologists, and ENT specialists 📞 Contact Dr. Nafaur Rahman for Emergency Pediatric Brain Infection Care Dr. Md. Nafaur Rahman Assistant Professor, Pediatric Neurosurgery, NINS Chief Consultant, Bangladesh Paediatric Neurocare Centre 📱 For Serial/Appointment: 📞 01912988182 | 📞 01607033535 🌐 Website: www.neurosurgeonnafaur.com
